Preoperative Beta-blocker Use Research Articles

Pre-Operative Beta-Blocker Use in High Risk Patients: Is There Room for Improvement?

Pre-Operative Beta-Blocker Use in High Risk Patients: Is There Room for Improvement?

Preoperative beta-Blocker Use and Mortality and Morbidity Following CABG Surgery in North America--Correction

Preoperative beta-Blocker Use and Mortality and Morbidity Following CABG Surgery in North America--Correction

Post-CABG Outcomes May Improve with Preoperative Beta-Blocker Use

Beta-blockers improve outcomes in a large majority of heart patients, but the effect of beta-blocker use before coronary artery bypass grafting (CABG)

Preoperative beta-blocker use and mortality and morbidity following CABG surgery in North America.

beta-Blockade therapy has recently been shown to convey a survival benefit in preoperative noncardiac vascular surgical settings. The effect of preoperative beta-blocker therapy on coronary artery bypass graft surgery (CABG) outcomes has not been assessed. To examine patterns of use of preoperative beta-blockers in patients undergoing isolated CABG and to determine whether use of beta-blockers is associated with lower operative mortality and morbidity. Observational study using the Society of Thoracic Surgeons National Adult Cardiac Surgery Database (NCD) to assess beta-blocker use and outcomes among 629 877 patients undergoing isolated CABG between 1996 and 1999 at 497 US and Canadian sites. Influence of beta-blockers on operative mortality, examined using both direct risk adjustment and a matched-pairs analysis based on propensity for preoperative beta-blocker therapy. From 1996 to 1999, overall use of preoperative beta-blockers increased from 50% to 60% in the NCD (P<.001 for time trend). Major predictors of use included recent myocardial infarction; hypertension; worse angina; younger age; better left ventricular systolic function; and absence of congestive heart failure, chronic lung disease, and diabetes. Patients who received beta-blockers had lower mortality than those who did not (unadjusted 30-day mortality, 2.8% vs 3.4%; odds ratio [OR], 0.80; 95% confidence interval [CI], 0.78-0.82). Preoperative beta-blocker use remained associated with slightly lower mortality after adjusting for patient risk and center effects using both risk adjustment (OR, 0.94; 95% CI, 0.91-0.97) and treatment propensity matching (OR, 0.97; 95% CI, 0.93-1.00). Procedural complications also tended to be lower among treated patients. This treatment advantage was seen among the majority of patient subgroups, including women; elderly persons; and those with chronic lung disease, diabetes, or moderately depressed ventricular function. Among patients with a left ventricular ejection fraction of less than 30%, however, preoperative beta-blocker therapy was associated with a trend toward a higher mortality rate (OR, 1.13; 95% CI, 0.96-1.33; P =.23). In this large North American observational analysis, preoperative beta-blocker therapy was associated with a small but consistent survival benefit for patients undergoing CABG, except among patients with a left ventricular ejection fraction of less than 30%. This analysis further suggests that preoperative beta-blocker therapy may be a useful process measure for CABG quality improvement assessment.

Ab-interno goniotrabeculotomy versus mitomycin C trabeculectomy for adult open-angle glaucoma: A 2-year randomized clinical trial

ObjectiveTo evaluate the effect of ab-interno goniotrabeculotomy (AIGT) on the intraocular pressure (IOP) in adult patients with primary open-angle glaucoma (POAG), compared with the effects of mitomycin C trabeculectomy (MT). DesignProspective, randomized, clinical trial. ParticipantsThirty-two eyes of 32 patients with medically uncontrolled POAG. InterventionStandard limbus-based trabeculectomy with adjunct mitomycin C (0.3 mg/mL for 3 minutes) in 16 eyes of 16 patients; AIGT was performed in 16 eyes of 16 patients. The groups were matched for age, preoperative IOP, duration of preoperative antiglaucoma treatment, use of preoperative beta-blockers and parasympathomimetics, and use of beta-blockers in the fellow eye. The IOP (average of the two highest values measured in the diurnal curve, from 8 am to 6 pm, every 2 hours) and complications were recorded 1, 3, 6, 12, 18, and 24 months after surgery. Main outcome measuresIdentification of complications and IOP. ResultsAll patients were followed up for 24 months. More postoperative complications occurred in the MT group during the 2-year follow-up. One month after surgery, IOP was 10 ± 1.46 mmHg (range, 8–13) in the MT group and 12.12 ± 1.63 mmHg (range, 8–14) in the AIGT group (Student’s t test, P = 0.001). Three months after surgery, IOP was 11.5 ± 1.59 mmHg (range, 8–14) and 12.75 ± 1.57 mmHg (range, 10–16) in the MT and AIGT groups, respectively (Student’s t test, P = 0.033). From the 6th to the 24th postoperative month, no statistically significant difference in IOP was found between the two groups. At the end of follow-up, 14 of 16 eyes (87.5%) of the AIGT group and 13 of the 16 eyes (81.25%) of the MT group showed an IOP ≤14 mmHg. ConclusionAb-interno goniotrabeculotomy appears to be a viable and safe surgical treatment for adult POAG. More extended follow-up, however, and a larger series of patients are needed to ascertain the actual effectiveness of this procedure in adult POAG.